Internal Medicine

Pre:

Post:

Symmetric diffuse, bilateral pulmonary infiltrates with mediastinal and bilateral hilar lymphadenopathy. DDx?

What do you want to do next?

Large peripancreatic retroperitoneal fluid collections with gas formation representing necrotizing pancreatitis.

80-year-old male who had a second- and third-degree burn injury was found to have an automated platelet's count of 980,000 while a manual analysis revealed it is 165,000. This is a heat-induced fragmentation of RBCS causing a false automated reading of the platelets.

Probe location (zone L3): 4th-10th intercostal spaces, between the anterior & posterior axillary lines.

Transducer Type & Placement

Phased Array or Curvilinear

The footprint is perpendicular to the skin with the marker pointing cephalad

Lung Sliding

Pleural line is found below the chest wall

Movement of pleura with breathing will generate the “lung sliding” sign

• Represents the sliding of the visceral pleura against the parietal pleura

• Using Color Flow (CF) can help identify the pleural line and its movement

Bat Sign: This sign is formed by the shadows of two ribs and the pleural line (looks like a bat flying towards you)

Comet Tail Artifact/B Lines

• Vertical lines, extending from the pleural line to the edge of the screen without fading

• Synchronized with lung sliding

• When present they will usually overshadow the A lines

• Represents thickening interlobular septa and extravascular lung water as in alveolar interstitial disease (pulmonary edema, ARDS...)

A Lines

Can be part of the normal lung signs

Represents normal artifact repetition(s) of the pleural line

Intervals between the A lines are equal to the distance between the skin and the original pleural line

When present without lung sliding, it may indicate the presence of pneumothorax

Radiography of fungal pneumonia

A, Right upper lobe nodule with surrounding ground-glass opacities (halo sign) in a patient with invasive aspergillosis. B, Diffuse ground-glass opacities in a patient with Pneumocystis pneumonia. C, Diffuse ground-glass opacities and scattered thin-walled pneumatoceles in a patient with Pneumocystis pneumonia. D, Peripheral small cavitary nodules in a patient with Candida endocarditis and septic emboli to the lungs.

Notice the structure and the abnormality indicated by the yellow arrow and give your diagnosis. @Everyone

Large areas of cytotoxic edema involving the bilateral cerebral hemispheres and right cerebellum consistent with acute or subacute ischemia associated with sulcal effacement and edema without significant midline shift.

Compare this to her normal CT of head few days ago:

The lung is anatomically divided into smaller units known as lobules, which are the smallest functional units of the lung visible to the naked eye. Each lobule is roughly hexagonal in shape and is bounded by connective tissue septa. Within these lobules, the lung's essential structures for gas exchange are contained, including terminal bronchioles, respiratory bronchioles, alveolar ducts, and alveoli. The terminal bronchiole, which is the smallest airway without alveoli, branches into several respiratory bronchioles, marking the transition where gas exchange begins. Blood supply to the lobules is via the pulmonary arteries and veins traveling through septa and branching along the bronchioles. Lymphatic vessels within the lobules help to maintain fluid balance and remove debris.

The "crazy paving" pattern on chest HRCT or standard CT refers to the appearance of ground-glass opacities with superimposed interlobular and intralobular septal thickening. This pattern is named for its resemblance to irregularly laid paving…

Spot Diagnosis??

Left Ventricular Thrombus

I used ultrasound-enhancing agent (DEFINITY)